RIQAS Point of Care

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RIQAS Point of Care

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Randox International Quality Assessment Scheme – RIQAS at the Point of Care

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Designed to improve the quality of Point of Care Testing (POCT) in locations such as pharmacies, GP surgeries, hospital out patient departments, sports clinics, supermarkets, diagnostic/treatment and walk-in centres, RIQAS Point of Care provides independent evidence of the accuracy and reliability of test results. Randox International Quality Assessment Scheme (RIQAS) is the world’s largest EQA scheme with over 47,000 participants in more than 139 countries.

Why RIQAS Point of Care?

About RIQAS Point of Care

  • How it Works

    On a monthly basis we will distribute an identical sample of blood to all participating sites.  Each participating site will test the sample in the same way they would test a real patient sample, then return their test results to RIQAS within a set time. The scheme is unique in distributing whole blood samples rather than serum based samples, this ensures that samples act identically to real patient samples at the point of care.

    An electronic report is then sent to participants, comparing their results with other participants using the same analyser.  Satisfactory and unsatisfactory performance is represented using a traffic light system, allowing instant identification of any issues. A more detailed breakdown of performance may be obtained if further information is required. With time, an overall picture will emerge showing whether results are consistently accurate and reliable or whether there may be an underlying analyser and/or operator issue.

    RIQAS Point of Care - How it works
  • Tests and Analysers

    Test Role
    HbA1c • Diagnosing diabetes mellitus
    • Monitoring treatment
    • Encouraging self-management
    Total Cholesterol & HDL Cholesterol • Risk factors for heart disease
    • Monitoring lipid lowering therapy
    C-Reactive Protein (CRP) • Early detection of infectious disease
    • Identifying need for antibiotic treatment
    Glucose • Diagnose and monitor diabetes
    • Monitor for the presence of hypoglycaemia
    (low blood glucose) and hyperglycaemia (high blood glucose)
    International Normalised Ratio (INR) • Used to measure the effect of anticoagulant
    drugs such as warfarin
    • Help diagnose a bleeding disorder; to help
    estimate the severity of liver disease
    Ketones • To determine whether excessive ketones are
    present in the blood, to detect diabetic
    ketoacidosis (DKA)
    Note – The RIQAS Point of Care range is constantly expanding to include new tests and analysers. Please contact us if your desired analyser or test is not currently displayed.
  • Ordering Information

    Panel Catalogue Number
    Lipids RQ9181/A
    Lipids + 1 panel RQ9181/B
    Lipids + 2 panels RQ9181/C
    Additional Sample RQ9181/D
  • What Participants Say

    Our unrivalled commitment to quality and service ensures high levels of customer satisfaction, this is evident from the responses to our latest customer satisfaction survey:

    “All in all a quick and efficient service”
    “Good online system”
    “Very helpful team”
    “Excellent training”
    “They are an experienced team”
    “Very satisfied with the service that we receive”
    “Very good value for money”
    “The website is great”
  • Distribution Dates

    Distribution Month Sample Distributed Result Submission Deadline
    March 2020 2nd March 11th March
    April 2020 6th April 15th April
    May 2020 4th May 13th May
    June 2020 1st June 10th June
    July 2020 6th July 15th July
    August 2020 3rd August 12th August
    September 2020 7th September 16th September
    October 2020 5th October 14th October
    November 2020 2nd November 11th November
    December 2020 7th December 16th December
  • Importance of Quality Assurance

    Quality assurance is an essential aspect of any clinical/diagnostic testing service and is aimed at ensuring the accuracy and reliability of patients’ results. The right result allows the right clinical advice to be offered in a timely manner. Quality assurance operates at two levels:

    Internal Quality Control

    Internal Quality Control includes operator training/ competency assessment, analyser/ test system maintenance, and adherence to policies/ processes. Whilst some point of care analysers include inbuilt quality checks, cross-check analysis against samples with known levels provides immediate assurance and evidence that a patient’s result is safe to report.

    External Quality Assessment

    External Quality Assessment involves analysis of samples with unknown levels that have been distributed by an external organisation. Participants are informed how their results compare with other participants, hence providing independent evidence of performance. Increasingly, participation in an external quality assessment scheme is becoming a mandatory requirement where health and healthcare services are being provided.

    EQA provides assurance to both staff and customers that testing provides accurate and reliable results.

    Want to know more?

    Visit our Importance of EQA page to learn more.

Want to know more?

Contact us or download the RIQAS Point of Care catalogue to learn more.

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Frequently Asked Questions

RIQAS

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RIQAS Past Panels

RIQAS (Randox International Quality Assessment Scheme) is the largest global EQA scheme with over 47,000 participants in more than 139 countries. Our range currently comprises 33 programmes and the majority of clinical testing.

What are RIQAS Past Panels?

Stemming from RIQAS, the world’s largest External Quality Assessment programme, RIQAS Past Panels* facilitate a series of QC and interlaboratory functions, including:

 

Method Validation

New Instrument Validation

Assay Evaluation

Poor Performance Troubleshooting

Staff Training

Available Panels

Available RIQAS Past Panels* include:

• Ammonia/ Ethanol
• Anti-TSH Receptor
Blood Gas
• BNP
• Cardiac
Cerebrospinal Fluid (CSF)
Clinical Chemistry
• Coagulation
• CO-Oximetry
• CYFRA 21-1
• ESR
• Glycated Haemoglobin (HbA1c)
• Haematology
• Human Urine
• Immunoassay
• Immunoassay Speciality 1
• Immunoassay Speciality 2
• Immunosuppressant Drugs
• Lipid
• Liquid Cardiac
• Maternal Screening
• Serology Epstein Barr Virus (EBV)
• Serology (HIV/ Hepatitis)
Serology (Syphilis)
Serology (ToRCH)
Specific Proteins
Sweat Testing
Therapeutic Drugs
• Trace Elements in Blood
• Trace Elements in Serum
• Trace Elements in Urine
• Urinalysis
• Urine Toxicology
*Product availability is dependent on RIQAS stock surplus levels.

Benefits of RIQAS Past Panels

Support Data Included

All RIQAS Past Panels are provided with an Excel document containing supporting data for the instrument and method of interest.

Multi Level Samples

RIQAS Past Panel samples span multiple levels, making them ideal for ensuring accurate instrument performance across the measuring range.

Comprehensive Reports

RIQAS Past Panels allow laboratories to receive comprehensive external QC reports even after program close.

For more information on RIQAS Past Panel availability or to take part in this EQA scheme, contact us today and speak to one of our friendly and knowledgeable sales representatives. 


Randox International Quality Assessment Scheme (RIQAS)

Randox International Quality Assessment Scheme is the world’s largest external quality assessment (EQA) scheme. Currently offering 33 programmes, RIQAS has more than 47,000 laboratory participants in over 139 countries.

RIQAS  | Key Benefits

Click each icon for full benefits
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User-Friendly Reports

Presented in a user-friendly, one page per parameter format, complimentary multi-instrument and interlaboratory RIQAS reports allow comparative performance assessment of all laboratory systems. Each End-of-Cycle report summarises performance compared to the previous cycle, allowing laboratories to identify quality improvement over time.

 

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Large Database of Users

With 47,000 RIQAS participants in 139 countries worldwide, a large peer group means more information is available for a wide range of instruments and methods. This therefore ensures greater accuracy and confidence, while reducing the level of uncertainty in results used for comparison.

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Consolidation

Comprising over 360 parameters across 33 comprehensive EQA programmes, RIQAS can streamline external quality assessment by significantly reducing the number of individual programmes needed. Consolidation is guaranteed to save laboratory time and money, with fewer samples to prepare, reports to interpret and number of kits to store.

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Report Frequency

Frequent reporting allows early identification of test system errors and implementation of any necessary corrective actions with minimum disruption to the lab, reducing costly errors with patient results. RIQAS offers bi-weekly, monthly, and quarterly options (programme specific), with a turnaround of less than 72 hours for most reports.

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Flexibility

With 33 flexible external quality assessment programmes available, RIQAS is suitable for every laboratory. Reduced parameter and reporting options are available for selected programmes, with the ability to register up to 5 instruments per programme at no extra cost this will help save money and facilitate comparative performance assessment.

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Result Entry

RIQAS.Net is a convenient, cloud based data entry system which allows participants to return results and view reports online in seconds. Participants can submit results directly into the online RIQAS database, where PDF reports are collated and emailed back to participants. Current and previous reports are available to download at anytime, ideal for on the go users.

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Accredited

RIQAS programmes are accepted by national and international accreditation bodies worldwide, including ISO 17043:2010 – ‘Conformity Assessment – General Requirements for Proficiency Testing’. This guarantees high quality programmes that are fit for purpose and assist laboratories in achieving their own accreditation.

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Quality Material

Every RIQAS sample is manufactured to the highest standard, spanning clinically relevant levels to allow identification of concentration related biases to ensure accurate instrument performance across the entire analytical range. Designed to be commutable, RIQAS samples are manufactured from human source material and are free from interfering preservatives, increasing confidence that performance mirrors that of patient samples.

RIQAS EQA Programmes

Choice and flexibility guaranteed with 33 programmes available.

RIQAS EQA Reports

User-friendly, one page reports available for each parameter.

*Please note, product availability may vary country to country.

More About RIQAS

What is External Quality Control?

External Quality Assessment retrospectively assesses performance against other laboratories using the same method and instrument, by analysing ‘blind’ samples as if they were patient samples. Results are frequently submitted for statistical analysis, following which each lab will receive an overall comparative report. Find out why EQA is important here.

Why Participate in an EQA Scheme?

Ideal Specifications of an EQA Provider

Large Database of Users

Large participation numbers

Liquid ready

Blind samples

RIQAS - Stable and consistent sample matrix

Stable and consistent sample matrix

 

Frequency

Frequent analysis

Highly Accredited

International accreditation

User-Friendly Reports

Detailed reports

RIQAS - Realitic range of analyte concentrations

Realistic range of analyte concentrations

RIQAS - sample matirx similar to patient sample

Samples react in the sample manner as patient samples

RIQAS - rapid feedback

Rapid feedback

Want to know more?

Get in touch or download our full RIQAS brochure

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RIQAS FAQs

RIQAS Past Panels

Quality Controls

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Infection: Making Sure You Get the Right Treatment

When you have an infection, it’s important to receive the correct diagnosis in order to access appropriate treatments. Misdiagnosis can not only lead to the prolonging of the infection, but could also prove detrimental to your long-term health, such as if you become resistant to certain anti-biotic strains through mistaken prescription.

Throughout this month, we’ve been highlighting how the Randox clinical product range can assess the impact of infection. The RX series’ dedicated testing panel comprises of IgA, hsCRP and ASO which are also available for third-party use. The extensive QC range caters for assessment of infectious disease testing in both liquid and lyophilised formats.

Reagents

The Randox range of third-party reagents enables the clinical analysis of 113 different analytes with comprehensive range measurements and excellent correlations to reference methods.

IgG (the most abundant antibody) and IgM (the first antibody made in response to infection) can be used in the diagnosis of Dengue Fever. This is significant as more than 40 % of the global population, in more than 100 countries, are at risk of the Dengue Virus.

IgA is an antibody that lines the mucous membranes lining the mouth, airways and digestive tract. A deficiency in IgA is common in patients with bronchitis, conjunctivitis and otitis media.

Other Randox assays that may be used to detect differing infections include: albuminferritinalpha-1-antitrypsin (AAT)complement C3complement C4haptoglobinCRP, alpha-1-acid glycoprotein (AGP) and anti-streptolysin (ASO).

RX series

The RX series range offers the most comprehensive testing profile for assessing infectious diseases within an individual. The RX series test menu possesses the most extensive infectious disease testing panel available to give an expansive picture of an individual’s health. The RX series zinc test will assess the levels of zinc in an individual, Zinc plays a significant role in an individual’s health s it’s functions include cell and enzyme production as well as wound healing.

To view the full RX series test menu click here.

Internal Quality Control

Randox has partnered with Qnostics to provide a wide range of molecular controls for infectious disease testing. Designed to meet the demand of today’s molecular diagnostics laboratory and laboratories carrying out Nucleic Acid Testing (NAT), the Qnostics Molecular Infectious Disease range comprises hundreds of characterised viral, bacterial and fungal targets covering a wide range of Transplant Associated Diseases, Respiratory Infections, Blood Borne Viruses, Sexually Transmitted Infections, Gastrointestinal Diseases and Central Nervous System Diseases.

External Quality Control

Randox have also partnered up with QCMD to offer a vast array of molecular EQA programmes for infectious disease testing. With an extensive database of over 2000 participants in over 100 countries, QCMD is one of the largest providers of molecular EQA in the field of molecular diagnostics.

Frequent challenges, comprehensive reports and international accreditation ensures the best assessment of test system performance.

For more information on how Randox is helping to diagnose infection accurately and effectively, visit www.randox.com.

 

 

 


September focus: Infection

Throughout the month of September, we will be highlighting on our social media channels how the Randox clinical range can help combat infections and infectious diseases through accurate and swift diagnosis, allowing the necessary steps to be taken in order to improve individual health.

What is infection?

Infection is the infiltration of an organism’s body tissues by disease-causing agents, their multiplication, and the reaction of host tissues to the infectious agents and toxins they produce. Infectious disease can also be known as communicable disease and transmissible disease.

How is the Randox helping to diagnose infection?

The Randox portfolio comprises of a wide range of products to combat infections including the RX series’ dedicated infectious disease testing panel, diagnostic reagents such as copper, potassium and sTfR and an extensive QC range catering for infectious disease testing in both liquid and lyophilised formats.

How can I limit my risk of contracting infection?

  • The most important way to reduce the spread of infection is to wash your hands regularly with soap and water
  • If you have an infection, get the appropriate vaccine and do not take antibiotics when they are not needed. This will only increase antibiotic-resistance
  • Stay at home if you are sick to limit the spread of infection
  • Use single-use tissues and dispose of them immediately after use
  • Do not share cups, glasses or cutlery
  • Do not touch your eyes, nose or mouth as viruses can transfer from your hands and in to the body

How can my workplace limit the spread of infection?

  • Have an infection control plan
  • Provide clean hand washing facilities
  • Offer alcohol-based hand sanitisers when regular facilities are not available
  • Provide boxes of single-use tissues and encourage their use
  • Remind staff not to share cups, glasses or cutlery
  • Remove newspapers and magazines from waiting areas
  • Encourage staff to regularly disinfect their workspaces
  • Make sure ventilation systems are working properly

For more information on how Randox is helping to diagnose infection, visit www.randox.com/infections.

 

 

 


Point of Care Testing (POCT) Explained

Point of Care Testing (POCT) Explained

Point of Care Testing (POCT) is the delivery of a test at the point in time at which the result will be used to make a decision and taking appropriate action resulting in an improved health outcome. It is also known as near patient, bed-side, extra-laboratory, decentralised, and ancillary testing [1]. It has been shown to reduce hospital stay time, reduce complications, and improve adherence to treatment [2].

Point of care testing is not a recent practice; many early diagnostic tests were administered at the bedside. However, analytical technology has progressed and multiple tests can be performed within minutes in a laboratory. Recently, this technology has been put into the hands of the staff near the patients [2]. There are two types of technology, benchtop analysers and hand held devices. Bench top systems are just smaller versions of laboratory analysers but some steps are automated. Hand held devices are simple in appearance but complex internally, they can manage several tasks including, adding reagents, separating cells from plasma, and reading colour or other measures.

BENEFITS OF POINT OF CARE TESTING

Results can be obtained faster, allowing for more immediate decisions meaning treatment can begin sooner. Patients can live a longer and higher quality life, helped by a reduction in the length of hospital stays.

Some benefits of POCT [2]:

•    Reduced number of clinic visits
•    Earlier discharge from hospital
•    Fewer unnecessary hospital admissions
•    Optimised drug treatment
•    More appropriate use of drugs
•    Reduced use of blood products
•    Reduced use of staff, equipment and space

Key objective

The main objective of Point of Care Testing is to generate results more quickly so that appropriate treatment can be provided, resulting in an improved patient outcome.

EFFECTIVE POINT OF CARE TESTING

Management

Accurate and reliable results can only be obtained if the patient and sample are treated correctly. Point of care testing is likely to be performed by staff with a limited technical background, so training and quality control are vital.

Outcomes

Proper analysis technique alone is not enough to ensure an accurate decision; any test will only be beneficial if the appropriate action is taken based on the result. The effectiveness of POCT is assessed in terms of the overall outcome of the patient.

WHERE DOES IT GO WRONG?

There are three phases in the POCT cycle: pre-analytical phase, analytical phase, and post-analytical phase. About 90% of quality issues are attributed to the pre-analytical and post-analytical phases [3]. These errors are mainly attributed to user error and can be caused by a number of issues including, selecting the wrong POCT device, not following manufacturer instructions, inadequate training, not adhering to appropriate QC practices, and many more.

The errors can usually be mitigated by implementing an action plan and ensuring it is executed exactly as designed, deviation from the action plan will lead to errors. Errors in POCT diagnostics can lead to misdiagnosis, improper treatment, costly follow-up procedures, and death.

Some strategies for improvement:

•    Ensure the POCT analyser is suitable for the kind of testing being undertaken
•    Ensure adequate QC to ensure your device is accurate and reliable
•    Develop a comprehensive training programme
•    Periodically carry out audits of POCT practices
THE NEED FOR QUALITY CONTROL

Internal Quality Control and External Quality Assessment is conducted to monitor the stability of the analytical measurement system and to alert the operator to a change that may lead to a medically significant error [6].

A study by Price, Smith and Bruel [8] was conducted on a number of labs over a period of time of up to 15 years. They discovered that test result performance improved with time and was associated with regular participation in External Quality Assessment (EQA) schemes and with the use of internal quality control (IQC) procedures.

Internal Quality Control

Internal Quality Control (IQC) is used to assess the day-to-day consistency of assay performance, providing quality assurance for patient results. IQC activities are among the ten most common POCT deficiencies. These may include performing and documenting quality control testing and taking the correct action for outliers [4]. This poor performance could be attributed to how IQC is viewed in POCT; users may lack appreciation of the potential for errors and may see the analyser as infallible, they likely see IQC as an additional workload as opposed to part of their testing routine.

CLSI regulations require risk assessment for each stage of patient testing alongside an implementation of a quality control plan. Below are some suggestions for how IQC should be conducted for POCT.

Conduct

IQC should be conducted when: a new lot of consumable is used; a patient result is queried; after maintenance; the device has been physically insulted. IQC should be conducted by the usual device operator so assurance can be provided for the whole testing process.

Training

ISO 22870 requires POCT users should be trained in the theory and practice of IQC [5]. Staff should be trained in every aspect of POCT including storage, preparation, frequency, documentation and basic troubleshooting.

Material

QC material for POCT should be obtained from a third party provider and not rely on material provided by the device manufacturer, the benefits of which are well documented. It should also contain analytes at clinically relevant concentrations, be provided ready-to-use, and be stable at ambient temperatures.

Results

All IQC results must be recorded with the date, time, user, decision to accept or reject, and any actions taken as appropriate. Locally assigned ranges alongside analyte-specific rules should be used to maximise error detection. An example of how IQC could be recorded and an action flowchart can be seen in Fig. A below.

Troubleshooting

There should be a protocol for required actions following a failed IQC. Any troubleshooting should be developed with knowledge of the most common errors and user capability.

Review

A monthly review should be conducted to identify persistent failures and trends.

The cost of IQC may also be a factor in resistance to IQC, however, while it is difficult to quantify, the cost of not conducting it may be greater in terms of human harm. A whitepaper is available detailing IQC in POCT (download).

Fig. A Examples of a manual IQC documentation, adapted from the Australian Government’s POCT General Practice [4]

Fig. A Examples of a manual IQC documentation, adapted from the Australian Government’s POCT General Practice  [4]. (Click to expand)

External Quality Assessment

External Quality Assessment (EQA) or Proficiency Testing (PT) involves running blind patient-like samples and comparing your results to peer results, in order to retrospectively monitor the accuracy of reporting. EQA samples should be treated as if they were a patient sample and therefore must be run by personnel who would normally use the device. This provides confidence in the reliability of patient test results. (Learn more about EQA)

Benefits of participation in an EQA programme include assessment of result accuracy, assessment over time, comparisons with instruments, methods and peers, and providing confidence in test results.

EQA for POCT is, in theory, similar to EQA in a large laboratory. There is a significant difference however, the POCT participants are usually health care professionals with little knowledge of laboratory medicine. A lack of understanding of the importance of EQA had led to a smaller percentage of sites participating than large laboratories.

A Good EQA Scheme

A good EQA scheme should offer:

•      Enables a comparison of performance between laboratories
•      Frequent reporting and rapid report turnaround time to minimise the amount of time an error can go unnoticed
•      High quality material in a format that works for you
•      Well-designed reports that allow for quick and easy troubleshooting of erroneous results at a glance
•      A sample matrix similar to a real patient sample
•      Large participant numbers to provide a large peer group to compare results to
•      A realistic range of analyte concentrations
•      Your entire range of tests in consolidated programmes, saving you time and money

“EQA should, as far as possible, cover the entire range of tests, and the entire examination process, from sample reception, preparation and analysis to interpretation and reporting.” [9]

ISO 15189

Conducting EQA in POCT

Below are some suggestions for how EQA should be conducted for POCT.

Conduct

EQA should be conducted by the operator who normally conducts patient testing to ensure the true workflow is assessed [6].

Material

EQA samples should be commutable, meaning they have the same numeric relationship between measurements procedures as is observed for a panel of patient samples (reacts the same as a real patient sample).

Report Frequency

Challenges / surveys should be frequent enough to identify systematic errors in a timely manner, affecting the fewest patient results [10].

Report Turnaround

A fast turnaround time allows test system errors to be identified sooner and necessary corrective actions to be taken immediately with minimum disruption to the lab.

Review

A regular review of past EQA results should be part of the cycle of quality.

Guidance

A POCT EQA provider should be able to provide assistance when the user is having difficulties.

Results

Individuals carrying out testing should have the correct knowledge to interpret results, choosing a scheme with easy to interpret results can help.

RANDOX POCT QUALITY CONTROL SOLUTIONS

Internal Quality Control

Randox offer a number of controls suitable for Point of Care Testing applications:

  • Acusera Blood Gas Control

    The Randox Acusera Blood Gas Quality Controls contain assayed target values for ten parameters, covering pH, pCO2, pO2, electrolytes, glucose and lactate. The material is provided in easy to open ampoules for added convenience and ease-of-use. The liquid ready-to-use nature of the control makes it ideal for use in point-of-care testing and on a wide range of blood gas instruments.

  • Acusera Liquid Cardiac Control

    The Randox Acusera Liquid Cardiac control is designed to be both convenient and easy to use. The liquid ready-to-use format makes it ideal for both clinical laboratories and point-of-care testing. Assayed, instrument specific values are provided for an impressive 8 cardiac markers including, NT-ProBNP, D-dimer and Troponin ensuring consolidation and flexibility. Furthermore, an open vial stability of 30 days for all analytes helps to keep waste and costs to a minimum.

  • Acusera Liquid HbA1c Control

    Conveniently supplied liquid ready-to-use the Liquid HbA1c control is ideally suited to both clinical laboratories and POCT helping to significantly reduce preparation time. With a stability of 30 days, waste and costs are also kept to a minimum.

  • Liquid Urine Control

    The Randox Acusera Liquid Urine quality control is designed to be both convenient and easy to use. The liquid ready-to-use format eliminates issues with pipetting and allows convenient storage at 2℃ – 8℃. Assayed instrument and method specific target values and ranges are provided for 18 commonly tested urine chemistry parameters.

External Quality Assessment

Randox offers RIQAS Point of Care, a simple EQA scheme designed for use in point of care settings. It is a single sample, single scheme programme featuring whole blood samples for authentic patient sample assessment.

Learn More
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RIQAS

RIQAS Point of Care

Acusera

References

[1] C. Price, A. St john and J. Hicks, “Point-of-care testing”, 2004. [Online]. Available: http://mldt.hu/upload/labor/document/PRICEP.pdf. [Accessed: 23- Jul- 2018].

[2] C. Price, “Point of care testing”, BMJ, vol. 322, pp. 1285-1288, 2001.

[3] A. Okorodudu, “Optimizing accuracy and precision for point-of-care tests”, Acutecaretesting.org, 2011. [Online]. Available: https://acutecaretesting.org/en/articles/optimizing-accuracy-and-precision-for-point-of-care-tests. [Accessed: 24- Jul- 2018].

[4] H. Holt and D. Freedman, “Internal quality control in point-of-care testing: where’s the evidence?”, Annals of Clinical Biochemistry, vol. 53, no. 2, pp. 233-239, 2016.

[5] “ISO 22870:2016 – Point-of-care testing (POCT) — Requirements for quality and competence”, Iso.org, 2018. [Online]. Available: https://www.iso.org/standard/71119.html. [Accessed: 25- Jul- 2018].

[6] J. Gill and M. Shephard, “The Conduct of Quality Control and Quality Assurance Testing for PoCT Outside the Laboratory”, Clin Biochem Rev., vol. 31, no. 3, pp. 85-88, 2010.

[7] A. Stavelin and S. Sandberg, “Essential aspects of external quality assurance for point-of-care testing”, Biochemia Medica, pp. 81-85, 2017.

[8] C. Price, I. Smith and A. Van den Bruel, “Improving the quality of point-of-care testing”, Family Practice, vol. 35, no. 4, pp. 358-364, 2017.

[9] “ISO 15189:2012 – Medical laboratories — Requirements for quality and competence”, Iso.org, 2018. [Online]. Available: https://www.iso.org/standard/56115.html. [Accessed: 31- Jul- 2018].

[10] J. Crilly, “Mythbusting: Frequency of EQA Reports”, Randox Laboratories, 2017.

[11] G. Kristensen and P. Meijer, “Interpretation of EQA results and EQA-based trouble shooting”, Biochemia Medica, pp. 49-62, 2017.


Nutritional status: copper deficiency

Did you know that copper is an essential trace mineral present in all tissues? It works with iron to help the body form red blood cells. It also helps keep the blood vessels, nerves, immune system and bones healthy while also aiding in iron absorption. In rare situations, copper deficiency can occur and lead to anaemia and osteoporosis.

Symptoms of copper deficiency include:

  • Fatigue & weakness as cells use copper to generate ATP, the body’s main source of energy. This means that copper deficiency could affect your energy levels.
  • Frequent sickness as copper plays an important role in maintaining a healthy immune system.
  • Weak and brittle bones as copper is involved in the processes that create cross-links inside your bones. These cross-links ensure bones are healthy and strong.
  • Problems with memory and learning as copper plays an important role in brain function and development.

Sensitivity to cold as copper, along with minerals like zinc, help maintain optimal thyroid gland function. Low thyroid levels can make you feel colder more easily.

There are many foods that are high in copper. These include leafy greens, including turnip, greens, spinach, kale and mustard greens. Asparagus and summer squash are two other excellent sources of copper while legumes, whole grains, nuts and seeds are also good sources of the substance.

Randox Reagents, RX and QC are helping to diagnose copper deficiency at the earliest possible stage. The Randox copper assay is used to measure the levels of copper in the blood in order to determine copper toxicity. Combining this with the Randox zinc assay can aid in identifying the cause of liver damage in a patient, leading to correct treatment and recovery.

Find out more about how Randox is helping to diagnose nutritional status and deficiencies here: https://www.randox.com/nutritional-status/

 

 

 

 


Importance of External Quality Assessment (EQA)

The Importance of External Quality Control

External Quality Assessment (EQA) / Proficiency Testing (PT) allows for a comparison of a laboratory’s testing procedures to other laboratories across the world. Comparisons can be made to a peer group of laboratories or to a reference laboratory.

EQA involves running blind patient-like samples, comparing your results to peer results, in order to retrospectively monitor the accuracy of reporting. EQA samples should be treated as if they were a patient sample and therefore must be run by personnel who would normally use the device. This provides confidence in the reliability of patient test results.

“EQA is defined as a system for objectively checking the laboratory’s performance using an external agency or facility.”
World Health Organisation (2009)
Benefits of EQA

Participating in an EQA scheme allows a laboratory to gather valuable data, this data can be used in a variety of ways [1]:

 

  • Enables a comparison of performance between laboratories.

     

  • Enables a comparison of performance between testing sites.
  • Provides an early warning for systematic errors.
  • Indicates areas for improvement.
  • Provides evidence of quality.
  • Identifies training areas.
  • Detects equipment faults, identify reagent problems and review staff training.
  • Compares performance to different analytical methods.

EQA provides assurance to both staff and customers that testing taking place at your laboratory provides accurate and reliable results. Problems can be identified early on and corrective action can be untaken. The reliability of methods, materials, and equipment can be evaluated and training can be developed and its impact monitored.

Large laboratory groups can compare their performance with sites across their group, ensuring accuracy and consistency no matter where testing takes place.

EQA participation is often a requirement for accreditation, gaining accreditation alone has a host of benefits, not least an increased confidence in results from customers, current and potential.

“Quality Control materials shall be periodically examined with a frequency that is based on the stability of the procedure and the risk of harm to the patient from an erroneous result” [2]
ISO 15189
Benefits of EQA in Point Of Care Testing (POCT)

Point of care testing (POCT) refers to testing that is performed near or at the site of a patient with the result leading to a possible change in the care of the patient. The popularity and demand for POCT has recently seen rapid growth, this comes from the advantages including the added convenience of being able to obtain a rapid result at the patient’s bedside, thus allowing immediate action, saving time and improving the potential outcome for the patient.

Although there are many benefits of using POCT devices in terms of their convenience, these benefits are only true if the results produced are both accurate and reliable. Ensuring accuracy and reliability is the primary responsibility of Quality Control.

EQA is strongly recommended for all point of care devices and is recommended by ISO 22870, which providesspecific requirements applicable to point-of-care testing and is intended to be used in conjunction with ISO 15189.

“There shall be participation in external quality assessment schemes” [3]
ISO 22870
WHAT MAKES A GOOD EQA SCHEME?

There are many External Quality Control schemes that come in different varieties. EQA schemes can be mandatory, required either by accreditation or law. Others are voluntary and carried out by laboratories who want to ensure that they are carrying out accurate testing and improve the quality of the lab’s performance [1].

A good EQA scheme should offer:

  • Enables a comparison of performance between laboratories.
  • Frequent reporting and rapid report turnaround time to minimise the amount of time an error can go unnoticed.
  • High quality material in a format that works for you.
  • Well-designed reports that allow for quick and easy troubleshooting of erroneous results at a glance.
  • A sample matrix similar to a real patient sample.
  • Large participant numbers to provide a large peer group to compare results to.
  • A realistic range of analyte concentrations.

     

  • Your entire range of tests in consolidated programmes, saving you time and money.
“EQA should, as far as possible, cover the entire range of tests, and the entire examination process, from sample reception, preparation and analysis to interpretation and reporting.” [2]
ISO 15189
LIMITATIONS OF EQA

EQA is a great tool for comparing against a peer group and maintaining an effective QC strategy, however, it has its limitations.

EQA / PT alone cannot provide a complete evaluation alone; it is important to also run third party controls regularly. You can find out about the importance of third party controls here.

EQA results can also be affected by variables not relating to patient samples, including preparation, clerical functions, matrix effects, and selection of method. The errors can appear to be a downside to EQA but it can be used as a way to evaluate staff performance as well as assay performance.

PARTICIPATING IN EQA

If possible, every laboratory should participate in an EQA scheme that covers all testing procedures. Laboratories need to develop a management process with the objective to assure that EQA samples are treated appropriately and in the same manner. This includes, sample handling, sample analysis, record keeping, investigating deficiencies, taking corrective actions, and communicating results with laboratory staff and management.

SOURCES OF ERROR

Problems at any stage of sample analysis can cause errors, when an error does happen, all elements of the process need to be checked. Some examples of errors:

Pre Analysis

•  Incorrect sample handling during preparation, shipping or storage

•  Improper storage

•  The material has expired

•  An error in manufacturing

Analysis

•  Instrument, calibration or reagent defects

•  Staff competency

•  Matrix effects

•  Incorrect analysis method

Post Analysis

•  Report misinterpretation

•  Clerical or transcription errors

•  Failure to take corrective action

QUICK SUMMARY
•  EQA is a system for objectively checking a laboratory’s performance using an external agency or facility [1].
•  Where possible, all laboratories should participate in an EQA scheme for all tests that they perform.
•  EQA samples should be treated in the same way as a patient sample, using the same procedures, instruments, methods, and staff who normally perform the testing.
• EQA provides valuable resources and data to effectively maintain accurate and reliable results and should be seen as educational.
RANDOX INTERNATIONAL QUALITY ASSESSMENT SCHEME (RIQAS)

Randox offers RIQAS, the largest EQA scheme in the world with over 45,000 participants across 133 countries, offering 33 consolidated programmes. Randox also offers a range of over 90 molecular programmes for infectious disease testing with Quality Control for Molecular Diseases (QCMD).

Features and Benefits

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Fully accredited to ISO/IEC 17043:2010

Outlines the general requirements for proficiency testing and demonstrates our commitment to quality.

 

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Consolidated programmes

Over 360 parameters in 33 comprehensive programmes, RIQAS streamlines EQA by reducing the number of programmes required.
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High frequency reporting

More frequent reporting allows for early detection of errors and allows corrective action to be taken much sooner, reports are retuned within 24-72 hours of the submission deadline.

 

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The highest quality material

All RIQAS programmes use the highest quality raw materials, this ensures that concentrations are clinically relevant and the sample performs like a real patient sample.
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User-friendly reports

RIQAS reports are presented in a simple one page per parameter format, facilitating performance assessment at a glance.

To learn more about RIQAS, visit the RIQAS homepage.

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RIQAS

RIQAS Point of Care

References

[1] WHO, Overview of External Quality Assessment (EQA). World Health Organisation, 2009.

[2] ISO 15189:2012 Medical laboratories — Requirements for quality and competence, 3rd ed. ISO, 2014.

[3] ISO 22870:2016 Point-of-care testing (POCT) — Requirements for quality and competence, 2nd ed. ISO, 2016.


RIQAS Point of Care – FAQs

RIQAS-POC-FAQ-Web-Banner Frequently Asked Questions

Why do I need to participate in an External Quality Assessment Scheme like RIQAS Point of Care?

Participation in an External Quality Assessment (EQA) scheme can help provide assurance and confidence that patient test results are accurate and reliable, therefore ensuring that the right clinical advice can be safely offered. Increasingly, commissioners of services like NHS Health Checks require assurance of satisfactory performance in an EQA scheme. In the UK, independent evidence of performance through participation in an EQA scheme is a requirement of the National Quality Assurance Advisory panel.

Read more about the importance and benefits of EQA

Is the RIQAS Point of Care scheme the right choice for us?

The RIQAS POC scheme is geared to assuring the quality of Point Of Care Testing in locations like pharmacies, General Practitioner surgeries, diagnostic/treatment and walk-in centres, sports clinics, and hospital out patients. Typically, the scheme is commissioned by a prime contractor (the client) on behalf of a chain of participants. The POC scheme complements the RIQAS scheme for laboratory-based analysers operated by specialist laboratory scientists.

Please contact us to determine which scheme is most suitable for your needs.

How many operators can be registered at each location?

As many as you wish. New operators can be added at any time, email addresses can be modified and the system is able to recognise operators who may be working at more than one location. In encouraging ownership responsibility for updates lies with the operators at each location.

What happens if we want to transfer an analyser to another location or replace an old analyser with a new one?

In order to participate in the next sample, distribution changes must be made before the 20th of each month. Participation contracts are renewable annually and new analysers can be added to the scheme at any time during the contract.

HOW LONG DO I HAVE TO PROCESS THE SAMPLE AND SUBMIT THE RESULTS?

Samples are typically distributed on the first Monday of the month, results should be submitted online via the RIQAS Point of Care software before 5pm the following Monday.  Please see the Distribution Timetable for further information.

HOW SHOULD I STORE MY SAMPLES?

Samples should be kept refrigerated at between 2-8oC.  Do not freeze.

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RIQAS Point of Care

RIQAS

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